Why we studied this topic

Public health laws that governments have adopted represent some of the most effective and cost-effective interventions known to preventive health. However, the ‘top-down’ implementation of such controls in marginalised populations including the world’s 400 million Indigenous people have often been harmful and discriminatory in practice, particularly where they have lacked Indigenous consultation. We wanted to better understand what role Indigenous communities have played in conceiving, shaping and implementing public health laws such that they lead to improved health and social outcomes.

What this paper adds

This global systematic review synthesised the evidence of effectiveness of legal interventions that were designed and implemented by Indigenous communities. We found that Indigenous-led controls were effective in reducing crime, injury deaths, injury, hospitalisations and per capita consumption.

What it means for policy

Our findings can help to inform Indigenous communities and policy makers of the benefits, challenges and weaknesses of specific legal interventions that have been used to control alcohol. Further, they provide support for public health law making that is more inclusive and respectful of Indigenous knowledge, leadership and consultation.

What was surprising?

Specific legal interventions, although similar in nature and scope, were effective in some communities and ineffective or even harmful in others. This underscores the fact that such controls need to take into account contextual factors as well as their potential impact on at-risk sectors of the population, such as those experiencing substance addiction, women and children.